Journal of critical care
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Journal of critical care · Oct 2020
ReviewA narrative review of pharmacologic de-resuscitation in the critically ill.
Despite evidence highlighting harms of fluid overload, minimal guidance exists on counteraction via utilization of diuretics in the de-resuscitation phase. While diuretics have been shown to decrease net volume and improve clinical outcomes in the critically ill, a lack of standardization surrounding selection of diuretic regimen or monitoring of de-resuscitation exists. Current monitoring parameters of de-resuscitation often rely on clinical signs of fluid overload, end organ recovery and other biochemical surrogate markers which are often deemed unreliable. ⋯ Loop diuretics are a widely available type of diuretic for removal of volume in patients with sufficient kidney function, with the potential for adjunct diuretics in special circumstances. At present, administration of diuretics within the broad critically ill population fails to find uniformity and often efficacy. Given the lack of randomized controlled trials in this susceptible population, we aim to provide a thorough therapeutic understanding of diuretic pharmacotherapy which is necessary in order to achieve desired goal of fluid balance and improve overall outcomes.
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Journal of critical care · Oct 2020
Identification of risk factors for hypertension and tachycardia upon dexmedetomidine discontinuation.
Dexmedetomidine may cause hypertension and tachycardia upon discontinuation. Risk factors are poorly described but may include prolonged infusion, higher doses, a history of hypertension, and abrupt cessation. This study aims to identify risk factors for hypertension and tachycardia upon dexmedetomidine discontinuation. ⋯ Approximately one third of patients experienced hypertension or tachycardia upon dexmedetomidine discontinuation. A past medical history of hypertension was the only independent risk factor identified in this study based on the clinical data collected.
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Journal of critical care · Oct 2020
Association between sepsis at ICU admission and mortality in patients with ICU-acquired pneumonia: An infectious second-hit model.
We explore the hypothesis that critically ill patients developing ICU-acquired pneumonia (ICU-AP) have worse outcomes and an altered inflammatory response if their ICU admission was sepsis-related. ⋯ Previous sepsis does not appear to predispose to higher mortality nor worse outcomes in patients who develop ICU-acquired pneumonia.
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Journal of critical care · Oct 2020
The role of serum cystatin C in estimation of renal function in survivors of critical illness.
Estimating renal function by serum creatinine after critical illness is a challenging problem. However, the role of cystatin C for estimation of the renal function in survivors of critical illness is unknown. We aimed to compare the performance of serum cystatin C- and serum creatinine-based eGFR against a reference GFR using 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) in survivors of critical illness. ⋯ In survivors of critical illness, we demonstrated limitations of estimating GFR by both currently available SCysC and SCr-based equations. Therefore, further studies are still needed to develop better eGFR equations.
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Journal of critical care · Oct 2020
Comparative StudyAdjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study.
Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock. ⋯ Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock.